[simpleazon-image align="right" asin="B000V3IV3O" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/317R0BJJLuL._SL160_.jpg" width="160"]Folk on the ketogenic diet usually test their ketogenic status using Ketostix. You wee on them and (hopefully) they go pink to purple.

However, they are significantly less than accurate!

Firstly, as you head towards “nutritional ketosis” two substances are produced that are found in the urine: acetoacetate and beta-hydroxybutyrate. It is the latter, beta-hydroxybutyrate that we are interested in, but, as Phinney and Volek say:

the strips that test for ketones in the urine detect the presence of acetoacetate, not beta-hydroxybutyrate

They go on:

In the kidney, this process of keto-adaptation is also complex. Over time, urine ketone excretion drops off … This decline in urine ketones happens over the same time-course that renal uric acid clearance returns to normal and thus may represent an adaptation in kidney organic acid metabolism in response to sustained carbohydrate restriction.

[simpleazon-image align="right" asin="B005CVV2AE" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/515TE8b8jLL._SL160_.jpg" width="106"]So we are not only measuring the wrong thing (acetoacetate vs beta-hydroxybutyrate), but over time acetoacetate excretion drops off (which is why so many people in ketogenic forums and Facebook groups keep asking why they are “no longer in ketosis” (as measured by the Ketostix) when they are being good and sticking to the diet. Phinney and Volek conclude:

These temporal changes in how the kidneys handle ketones make urine ketone testing a rather uncertain if not undependable way of monitoring dietary response/adherence. Testing serum for beta-hydroxybutyrate is much more accurate but requires drawing blood, and it is expensive because it is not a routine test that doctors normally order.

Well, there’s something they didn’t know when they wrote that: you can now do serum testing (testing the level of beta-hydroxybutyrate in your blood) at home with a simple meter that is similar to a blood glucose meter.

I have recently found a brand-new meter, an upgrade from the Precision Xtra, which is called the Freestyle Optium. I got mine for free! Further down this post, I will tell you how (although it may only be possible in the UK). So what follows between the rules is how it was until recently, and how it may still be outside the UK.

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There are a couple of meters you can use, and they have been tested and compared by Jimmy Moore in his n=1 reports on his own progress with nutritional ketosis. One of the meters comes out badly in his review: you have to remember that these meters were not intended for the likes of us, who are trying to achieve nutritional ketosis, as defined by Phinney and Volek.

They are designed for Type 1 diabetics who are trying to avoid keto-acidosis (more of this further down this blog post). Which is why one of the meters just says “LO” for low measurements: that’s good enough (and good news) for someone who is Type 1.

Jimmy comes out in favour of [simpleazon-link asin="B0000537OO" locale="uk"]Precision Xtra Meter[/simpleazon-link], because it is capable of the levels of accuracy that we need.

However, especially if you live outside the USA (like, in the UK, as I do for a significant part of the year) the cost of the test strips for the Precision Xtra is a serious expense. In Amazon UK this pack is £66 plus £2 delivery for 10 (yes, that’s right, TEN!) strips. [simpleazon-image align="left" asin="B001EL30TM" locale="uk" height="160" src="http://ecx.images-amazon.com/images/I/21xRxYm7hhL._SL160_.jpg" width="160"]

That comes to £6.80 every time you do a test. I suspect you won’t test all that often! The meter from Amazon.co.uk is £25.48, including delivery.

If you are in the USA, the cheapest place I have found to get a Precision Xtra is MedExSupply.com, where, at the time of writing (August 10, 2013), it was $18.00. The best source of test strips is Universal Drugstore in Canada, where they come out at $2.00 a strip (plus $7.00 shipping). UDS need a prescription from your physician:here’s the e-mail they sent me describing what they need: Universal Drugstore e-mail.

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However, that’s the bad news. Here’s the good news: I just got a brand-new, latest model meter for free, and 10 β-ketone test strips for £16.99. (Actually, I bought three boxes and paid extra for express delivery.) That comes out to $2.55 a test.

Abbott Freestyle Optium

I had got so frustrated with my research that I Googled Abbott (the makers of the Precision Xtra) and discovered that they have a company in the UK, Abbott Diabetes Care. I called them and asked them about the Precision Xtra and they said that there’s a new model, the Freestyle Optium, and would I like them to send me one for free. I said yes, and two days later it arrived. It is a very cool little machine!

In fact when I first read Gary’s [simpleazon-link asin="0307474259" locale="us"]Why We Get Fat: And What to Do About It[/simpleazon-link] he immediately became a hero of mine.

Gary is a science journalist, rather than a practising scientist (although, I happen to believe, with a sharper scientific mind than many who are practising scientists). For a significant part of his career he has majored in writing about bad science–which is what first got him interested in nutrition. But whereas when he was writing about the bad science of cold fusion he was content to just tell the story, he has become much more deeply involved with nutrition and, last September (2012), with Peter Attia, he set up the Nutrition Science Initiative (NuSI).

I have always found both Gary and Peter quite scary: they have brains much sharper than mine (and I’m no fool), and they also have a level of personal discipline and persistence that I can only envy. So I was pretty much moved to tears when I watched Peter’s recent TEDMED talk, when he, too was almost moved to tears. See what you think.

httpv://www.youtube.com/watch?v=U3oI104STzs

For a less emotional, more factual introduction to NuSI and its work, spend three minutes with this video:

httpv://www.youtube.com/watch?v=HmfA9XFw-uU

Peter is also running a blog covering some of the most burning questions that individuals have: what should I eat, should I be concerned about cholesterol, how can I protect myself from the major “diseases of civilisation” on his own website, The Eating Academy. To begin to study what Peter has to say, start on the Eating Academy’s “Start Here” page.

Peter is at pains to explain scientific concepts in everyday language, but I have to say, his blogs sometimes make me work hard, and I suspect they may leave some of the readers of Live Free From Obesity gasping for air!

Don’t worry, I will make it my task to translate the more difficult posts into still simpler language, so that people with little of no scientific training, but who are eager to understand Why We Get Fat, And What To Do About It, can take the news on board!

The mainstay of our Keto life are the amazing keto rolls. When people ask “what is keto?”, rather than tell them what we don’t eat, we give them some crispy bacon in a keto roll, and tell them that this is what we do eat (plenty of butter on the roll, too).

Then we tell them that there’s no flour or sugar in the roll. It tends to go easily after that!

To get our version of the recipe, right click here: Keto Rolls, and select “Save As” (or whatever your browser says). There are many other versions!

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Update!

It turns out that Susan has a new preferred keto roll recipe from nutritional blogger Maria Emmerich. Susan says that the recipe above is good, but not reliable. Sometimes the rolls are fine (just look at them in those pictures!) and sometimes they come out looking like … well, sort of flattened pancakes. And solid!

Here’s Maria, making keto bread:

[vimeo clip_id="68001848"]

And you can find more details of Maria’s recipe on her blog page “Toasted Sub Sandwich and Panini” (Scroll down until you get to: “HEALTHIFIED” SUB (June 2013 update!)).

James’ Salsa Recipe

If you don’t like sharp and hot flavours, then this isn’t for you. But if you, like me, hanker after vinegary, chilli flavours, then this will accompany almost anything! And as tomatoes come into season, substitute the canned tomatoes with fresh ones: preferably home grown.

Primal Docs

Primal Docs is a network of over 400 physicians, healthcare practitioners, and independent businesses with a practical and evolutionary approach to health and nutrition. We are at the forefront of what is “Real Healthcare Reform”.

Paleo Physicians Network

The Mission:The purpose of the Paleo Physicians Network (PPN) is to provide a simple interface between health conscious consumers and the medical professionals who practice Darwinian/Evolutionary Medicine.

Health practitioners in the PPN share these values:For non-emergent (life threatening) situations the first intervention for most issues should derive from an Evolutionarily consistent framework including, Paleo Nutrition, sleep patterns, socialization, and exercise which is consistent with the processes which formed the H. Sapien genome.

Jimmy Moore’s Low Carb Doctors

A list of all the low-carb doctors across the United States and around the world so that people who want to learn more about this miraculous way of eating and how it can change their life like it did for me and so many more can find a friendly, caring physician ready to help them do it the right way. Too often we are left to our own devices without any medical assistance when we start on a diet. Use this resource to find doctors who will SUPPORT you, not BLAME you for your obesity and disease.

“In my diet plan it says I can eat as much as I want. How does that work?”

“I’m confused: should I count calories or not?”

“My doctor says that Gary Taubes is wrong: you can’t contradict physics. I’m fat because I eat too much and don’t exercise enough”

We hear this all the time, and questions like this appear in Facebook groups and diet forums all the time. Frequently with people saying something like “excuse me for being stupid“.

We will put that last one to bed straight away. You are not stupid!

Let’s deal with “eat as much as you want“. First, how much do you want?

Your body has sophisticated control mechanisms to tell you:

You’re hungry: you need fuel (food)

You are full: you’ve had enough

Click this picture: you may get a surprise!

However, unfortunately you have two completely different mechanisms in this control system:

Biochemistry

Psychology and emotions

Frequently our psychology and emotions around food get messed up. It starts with parental messages to eat up all your dinner or children will starve in Africa and is then manipulated by the HUGE sums of money that advertisers spend to program our brains to make us eat.

Our biochemistry also gets messed up. When I was a lad growing up in England, Chinese restaurants were novelty. There was a piece of “received wisdom” that said that you would feel hungry again half an hour after eating Chinese food. Cecil Adams in “The Straight Dope” even wrote an article about it. (Click those links: they are more fun than this blog post is likely to be!)

The point is that some food makes you feel full up, some food leaves you hungry and there is some food that actually makes you hungry (mostly manufactured food, manufactured by firms with no interest in you being healthy, just in you buying more of their products.

So, leaving on one side the psychology and emotions for a moment, if you STOP eating the stuff that doesn’t make you feel food, and replace it by eating the stuff that does make you feel full, then we can say “eat as much as you like”, reckoning that you will get to feel full quite quickly, that that will be “as much as you like” and you’ll eat less, and lose weight.

But maybe the “see food” thing isn’t a joke. Maybe it’s the truth. Spend a couple of minutes watching this experiment carried out by stage hypnotist Paul McKenna:

httpv://www.youtube.com/watch?v=AbDFnI_fMd4

You might like to try it for yourself.

And how would it be if someone fed you, rather than you feeding yourself? My guess is that each mouthful will be smaller and that your “eating speed” will be slower.

I think that we have learned to bypass or over-ride our “satiety” signals, and if we could fix that problem, then we would feel full sooner, and we would eat less.

But notice what I said there: “we would eat less”.

Losing weight is all about eating less. It’s about doing something that will mean that we are happy to stop eating when we are full. It is not about forcing ourselves to eat less. That never, ever works. And if you think it does, just look around you. All over the western world for at least the last half century, doctors, nutritionists and diet pundits have been telling overweight people to, “eat less, exercise more”.

Does it look like this advice is working? I don’t think so.

And then along comes Gary Taubes with his two books, [simpleazon-link asin="1400033462" locale="us"]Good Calories, Bad Calories[/simpleazon-link] ([simpleazon-link asin="0091924286" locale="uk"]The Diet Delusion[/simpleazon-link] in the UK) and [simpleazon-link asin="0307474259" locale="us"]Why We Get Fat: And What to Do About It[/simpleazon-link]. The book (WWGF) changed my life. Here’s why.

There is a subtle subtext behind “If you eat less and exercise more you will lose weight” which says “you are fat because you are greedy and lazy“. Gee, thanks doc.

When Gary says that this isn’t the way to go with this all the conventional pundits cry “foul”. They say it’s all a question of physics. If you take in more energy than you put out, that excess energy has to go somewhere and it will be stored as fat. Therefore, take in less energy and/or put out more energy, or both. It’s all physics and Gary Taubes should be burned at the stake (steak?) for saying otherwise.

But Gary does NOT go against the laws of physics. Read the above paragraph again, but stop at the word “Therefore”. There should be a whole book, or maybe a whole library, between “stored as fat.” and “Therefore …”

Here’s an example that Gary uses quite a lot. Think of a teenage boy. There comes a certain age where they seem to grow (tall) overnight. And they seem to be always in the fridge, except when they are in bed. But you don’t ever hear a parent say “My Tommy has grown six inches in the last three months, it must be because he’s eating too much and not exercising enough”. He is eating because he is growing. He lacks energy because all his energy is going into growing. And why is he growing? Well, we know, don’t we. It’s his hormones.

And it’s our hormones that make us grow fatter, too. It’s just different hormones. With Tommy it’s testosterone and somatropin, with me it’s insulin. With Tommy it’s supposed to happen: if his testosterone and somatropin get out of whack he’ll either not grow, or he’ll be a giant. My insulin is out of whack: I’m only a giant width-wise. And it was eating too many refined carbohydrates when I was young and foolish (and middle-aged and foolish) as opposed to now when I am old and foolish, that damaged my insulin system.

But I’m getting off subject, or at least on to a subject that I’ll come back to later.

So, Do I have to Count Calories? Yes or No?

Well, it depends (sorry!) You will only lose weight if you correct that energy balance: eat less or exercise more (actually, exercising more probably won’t help: it’ll just make you hungry).

What we hope is that by eating less processed junk food, less refined carbs, by eating more “real food” (what your grandparents called “food”), by eating a balanced amount of protein and upping the amount of fats that you eat (etc etc: we’ll deal with precisely what elsewhere), you will naturally want to eat less.

The trick to losing weight while eating as much as you like is to change how much you like.

So if you are following your low-carb diet, or your paleo or primal regime or your ketogenic or auto-immune protocol, and you are not losing weight, then you are eating too much … BUT, the answer is not to just cut down, but to find out why. If you are significantly obese then it is highly likely that switching to a paleo or ketogenic regime will cause you to lose weight, without having to count calories. You will just naturally want to eat fewer calories. You’ll feel full up sooner.

But as you get closer to your goal weight, where the margins for calculation are tighter, you may need to exercise more control. You may need to count something … not necessarily calories: it may be grams of carbs, or it may be getting the macro-nutrient ratios right. It may be paying better attention to micro-nutrients. I have heard it said that if we are missing certain micro nutrients in our diet that we may crave certain foods. I have also heard it said that modern food is only around half as nutrient dense as food that was commonly available 100 years ago. So, presumably, we need to eat twice as much (and hence get twice as many calories) just to get the same level of micro nutrients.

Or it may be finding a way to re-wire your brain, so that you find more effective ways of supporting starving African children, other than by eating more than you need yourself.

As so many of my articles conclude, it is highly likely that no-one has an off-the-peg answer to your individual question. Research is needed. The question is, will you pay a Harley Street nutritionist £125 per hour to do the research, or will you learn about food, nutrition and your own body, and do your own research?

Go on, give me a hint!

Zoe Salmon

Some while ago the BBC made a programme called “The Big Fat Truth About Low Fat Foods“. I like this programme because they took an ordinary person (well, as ordinary a you can be, being an ex Blue-Peter presenter and an FHM model) and put her on a low-fat, packaged food diet for four weeks, to see what would happen. She is “ordinary” in the sense that she doesn’t have any particular health problems, is not a diet and nutrition expert, but generally eats a reasonable diet.

(Having said that, I just discovered that she was a contestant in Celebrity Masterchef!!)

For four weeks, model and former Blue Peter presenter Zoe Salmon ditches the fine dining she’s used to and lives on nothing but pre-packaged, highly-processed foods that are labelled either low or lower in fat. She finds out what’s in these foods and how they affect her moods, nutritional levels and, crucially, her weight. She also meets the low calorie converts who say that eating this way isn’t just a diet, but a way of life.

The programme (I think) does for Weight Watchers what “Supersize Me” did for Macdonalds. I think the programme is a must to show to anyone who thinks your high-fat diet will kill you, and a must for anyone considering Weight Watchers. Here’s a trailer:

A frequent question in these communities is “what should I eat?” This question might mean “what proportion of carbs, proteins, and fats should I eat?” It might mean “what actual foods can I eat, and in what quantities?” In every case the answer is always “it depends …” which is highly frustrating for the person asking the question.

There are some calculators out there, but quite a few people, especially those less confident as computer users, or less confident with math (or both) have had trouble using them. This blog post intends to help!

At the moment it is only talking about one calculator, Martin Ankerl‘s Keto Calculator: http://keto-calculator.ankerl.com/. This video should explain all. Below are some links that you might find helpful. Some notes appear as the video runs: you will find them easier to read if you make the video full screen (click the icon in the bottom right of the video).

httpv://www.youtube.com/watch?v=vyRnunLjDvI

kcal or kilo-calories. It’s all very confusing, but a calorie is the amount of heat that it takes to warm up one cc of water by one degree centigrade. A Calorie (with a capital “C”), also known as a kilo-calorie (kcal) is what nutritionists use, and most people just lose the “k” and don’t bother with the capital “C”. So, if you see kcal or kilo-calorie, just know that that is what dieters call a “calorie”. Summary: don’t worry: ignore the “k”!

Body Fat Percentage: What percentage of your weight is body fat. There are various ways of measuring it. Many fancy modern bathroom scales will do it for you, if you just step on in bare feet. Pictures on the left for USA, on the right for UK.

A simpler method is to look at pictures of people, labelled with their body fat, and pick out the nearest to you. There is a good set of body-fat pictures here.

MFP: My Fitness Pal — software to help you keep a food and exercise log, and work out what you have eaten in terms of carbs, protein and fats. (It’s free!) Go to their home page, scroll down a little and watch the video. I am not going to create a MyFitnessPal “how to” video, because there are dozens on You Tube. Here’s one I picked at random: